歯内療法用ファイルの誤飲事故：症例報告

Accidental ingestion of an endodontic file: a case report.

抄録

背景:

歯科手術中に歯科用器具を誤飲することは稀であるが、重篤な合併症を引き起こす可能性がある。本稿では、歯内療法中に歯内療法用ハンドファイルを誤ってその場に置き忘れた症例を紹介する。プレーンX線写真で位置を確認し、連続画像で消化管内の歯内療法用ファイルの通過を監視し、最終的に介入することなく通過した。最後に，摂取した歯科用器具の監視・管理方法について述べる．

BACKGROUND: Ingestion of dental instruments is rare during dental surgery but can result in serious complications. Here we describe a case in which an endodontic hand file was accidentally misplaced in situ during endodontic (root canal) therapy. Plain radiographs were used to identify its location, and serial imaging was used to monitor passage of the endodontic file through the gastrointestinal tract, and it ultimately passed without intervention. We conclude by describing methods for surveillance and management of ingested dental instruments.

症例報告:

62歳白人男性が歯内療法用ハンドファイルの誤飲あるいは吸入が疑われ、約2時間後に救急外来を受診した。歯内療法中に2回の過度の咳嗽と呼吸困難を経験し，歯科医から詳細な調査のため速やかに紹介された．入院時，腹部単純X線写真によりファイルが十二指腸内にあることを確認し，連続X線写真によりファイルの消化管内移行とクリアランスを観察した．この間，患者は腸管穿孔の臨床的徴候を示さず，X線写真上では気腹の証拠もなかった．最終的にX線写真で異物がないことが確認され、患者は退院した。

CASE REPORT: A 62-year-old Caucasian male presented to the Emergency Department approximately 2 hours after suspected ingestion or inhalation of an endodontic hand file. He had experienced two episodes of excessive coughing and dyspnea while undergoing endodontic therapy, and was promptly referred by his dentist for further investigation. On admission, plain abdominal radiographs confirmed the position of the file in the duodenum, and serial radiographs were used to monitor its transition and clearance through the gastrointestinal tract. During this time, the patient did not demonstrate any clinical signs of bowel perforation, nor was there any radiographic evidence of pneumoperitonium. The patient was discharged after a final radiograph confirmed the absence of the foreign body.

結論:

歯科用器具の誤飲・誤食は生命を脅かす可能性があり，内視鏡的回収，緊急開腹，外科的介入の可能性を考慮し，一般外科医，消化器内科医，呼吸器内科医に早期に相談して慎重に管理する必要がある．画像検査は、異物の位置を確認し、回収が可能かどうかを判断するのに有用であり、最終的には異物の位置と特徴、および穿孔、閉塞、または嵌頓の可能性を高める患者の危険因子によって管理方法が異なることになる。

CONCLUSION: Ingestion and inhalation of dental instruments can be life threatening and should be managed cautiously, with early input from general surgeons, gastroenterologists, or respiratory physicians for possible endoscopic retrieval, emergent laparotomy, or surgical intervention. Imaging studies are useful for discerning the position of the foreign body and to determine whether retrieval is possible, and the management will ultimately depend on the position and characteristics of the foreign body, as well as risk factors from the patient which may increase the likelihood of perforation, obstruction, or impaction.